[Question #6428] Please do not remove. This question is

14 months ago
Hi,

I'm very sorry for coming here yet again to ask an HPV question. I'm back because in one of my past questions, I referenced Dr. Hansfield past response and was unable to quote it. I have now found the exact response and quote and was wondering if I could please get clarification since I still see a discrepancy. I'm not anxious I'm just genuinely confused and looking for a non contradictory information. Please allow me to ask this question so I don't have to keep wondering about it. I trust all the experts on this forum greatly which is why I'm coming back here for your clarification.

In the same thread -- question #5814 "HPV transmission" from 4 months ago --- I see the below 2 statements.

"So the current state of research, and these comments, leave a lot of uncertainty and hence anxiety by many infected or potentially infected persons. But the most important facts remain that 1) most people get HPV and can't do much about it (so why worry?); 2) most infections cause no harm and are cleared by the immune system to a point they cannot be transmitted and are unlikely to reactivate ..."
"The 90% figure probably is about right for suppression by the immune system, but later reactivation probably occurs in more than 10% (maybe up to 50%) of infected persons."

This is contradictory to me. How can an infection be unlikely to reactivate but also reactivate in up to 50% of persons? I am not challenging anyone at all. I am just confused. In my previous question, I was told that perhaps this was referencing reactivation rates a few years years after initial infection, but nowhere does it say that, in fact it says that within 2 years 90% of infections will clear (not reactivate). Please clear this up for me. I would extremely appreciate it.  Is HPV reactivation as high as 50%? is this 'reactivation' significant enough to be infectious to others?
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

I'm sorry you felt the need to return to the site with continued speculative questions about an HPV infection which resolved more than 9 years ago.  I do not see anything contradictory in the multiple earlier interactions you have had with either myself of Dr. Handsfield.  Further, I want to once again emphasize that your concerns are speculative since you have NOT be found to have evidence of infection since resolution of your initial infection and, even if you did, the risk of adverse consequences or transmission from a recurrence are low.  Let me review some of what you have already had said in prior questions:

1.  Over 90% of HPV infections detected using standard testing will resolve, typically in the year or so after infection.

2.  Some of these infections, 10-20% will recur in the year after resolving.  Additional infections will continue to recur/be detectable later, some experts suggest that up to 50% ( but less than half, i.e. most) will recur later, over time.

In addition, for purposes of clarification- when these infections recur, less virus is present than earlier in infection, before resolution.   With less virus, transmission of infection to others is also less likely to occur.  In your case, with no evidence of recurrence after 9 years. your risk for recurrence (and therefore risk of transmitting your past infection) is, if anything, lower than average but no specific data are available to better quantify the risk).

I strongly considered simply closing this thread without any response.  Instead in an effort to give you closure, I have tried once again.  Despite your statement to the contrary, to this reader, your question does appear focused on nuance, to be repetitive and to reflect continuing speculative anxiety on your part.  Further relies, if at all, will be brief.  EWH

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14 months ago
Thank you.

<rant> The fact that we don't have any consensual hard data on such a common virus regarding transmission (given the carcinogenic capacity) is beyond me. There is no cure, and no antiviral therapy, so I'm confused as to why they even test women for it; especially since the most basic question about transmission cannot be answered with consensus. Pap tests should be enough  </rant>

Given that reactivation (and thus, presumably transmission) happen as often as 50% of the time, what is your experience in older women reactivating? At what age does this usually happen?
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

I'm sorry this upsets you. Please remember that 30 years ago scientists were just beginning to appreciate the links between HPV and genital tract cancer, an observation which led the discoverer to receipt of the Nobel prize.  Then to learn and understand the natural history of a process which evolves over decades can logically take decades to expect otherwise is unreasonable!.  From a scientific perspective the rate at which knowledge has accumulated is truly remarkable and unparalleled.  Further, while there remain important questions to be answered and more precision is always desirable, the FACT is that is that it is clear that that widespread infection is innocuous for most persons with infection and for the tiny proportion of persons in whom it progresses to cause more serious problems, the progression is slow and readily detected and managed by following recommended sexual health screening guidelines. 

The occurrence of infection in older women is low and, In my experience reactivation in older women is quite uncommon, as is transmission.  Precise data on the frequency of this is not available, in part because it is rare.  EWH

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14 months ago
As always, thank you. I have no further questions.
14 months ago
wait actually one last minescule clarification.

By older women I do not mean elderly women. I  mean women 40-55 years or so; how common is hpv reactivation/transmission in this age category (given your experience). I know hpv rates decrease after age 60. Does your same answer still stand?
Edward W. Hook M.D.
Edward W. Hook M.D.
14 months ago

I did not mean elderly women either.  My answer was directed at women in the late 40s and older.  Once again, after 9+ years since resolution of your HPV, I would not be worrying about reactivation or the potential for transmission to others.

As you know, this is the 3rd and therefore final reply as part of this thread which will now be closed.  I must warn you that further questions on this topic where there is so little data may be closed without a reply and without return of your posting fee.  I do hope that the information I have provided has been helpful.  Take care, please don't worry.  EWH

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